Diarrhea / Incontinence / Constipation

Most people think of diarrhea as the watery substances that comes through the anus.  But I would maintain that diarrhea can also be described as soft stool, peanut butter consistency, consistency of toothpaste, mushy, cow pies, or the size and consistency of a brown banana.  All of these descriptions are also diarrhea. Another thought is that if you wipe and there is residual stool on the toilet paper your stools are too soft or you are having diarrhea.

How do you correct diarrhea?

It depends on the etiology of the diarrhea.

The most common etiology is food poisoning.  Most people think of food poisoning as bacterial.  If one expands this view and recognizes that foods that you are intolerant of like milk or food that you are allergic to also cause diarrhea.  The treatment becomes apparent.

In 2013 the genetic basis for the formation of the enzyme lactase was found.  The majority of people in fact well over 90% of people do not make the enzyme lactase that will digest milk.  This does not mean you can not eat or drink milk.  It just means that if you consume enough it will cause diarrhea.

As the most common cause of diarrhea is food/bacterial related.  Generally the first step is Peptobismal.  The bismuth salt is a heavy metal with a 2+ anion which will kill all bacteria that it comes in contact.  The use of Peptobismal is effective in many if not most cases. Once completed the dietary choice should become a focus on 30gms of fiber a day at a minimum.  Withing 2-3 days after an event of diarrhea things should return to normal.

A list of food to avoid and to consume provide that road to the normal stool.
What to Avoid
Dairy: Milk, Cheese, Ice cream etc a health alternative rice or almond milk
Sugar: a healthy alternative honey
Flour: Use spinach tortillas, rice paper, rice noodles, etc
Meat: This includes all red beef, chicken and pork Use healthy alternative fish once a week
Do not take laxatives, No magnesium, check for magnesium containing medicines and vitamins
Do not take Senna or cascara a major ingredient in Plant or Tea base health products
What to Eat
Daily 10grams of fiber at each meal or 30 grams of fiber at a minimum each day.
Vegetables: bok choy, broccoli, Brussel sprouts, cabbage, callards, kale , squash, asparagus onions garlic, tomatores zucchini mushrooms swiss chard
Beans : kidney xxx gms/serving, pinto, black, chick peas, lentils, peas, blaeyed peas, soybeans
Fruits: berries, cherries, pomogranit, melons, kiwi, pineapple, peaches, plums, pears, bananas, grapes and apples and oranges
Seeds and Nuts: Almond, sunflower ( highest protein( chia, flax, sesame, pumpkin, pistachios cashews and walnuts pecans,
Whole Grains: black rice, brown rice, oats, whole wheat, quinoa
In addition for good health and treatment or all ailments


Add chopped onions daily
Mushrooms daily
Large salad daily
Hand full of nuts and seeds daily
Beans daily ½ cup
Green vegetables two servins
Fresh Frutis and berries 3 servings a day

But if your stool still is too soft or poorly formed the missing ingredient for normal stool formation is bacteria.  Patients who have been on antibiotics such as Zpack (Zithromycin) or Clindamycin often have trouble returning to normal without an antibiotic.  This is made worse by absence of an appendix.   So often will need recolonize the colon with probiotic VSL#3.  VSL#3 is obtained from the pharmacist.

Clearly the appropriate treatment of diarrhea begins with a good and thorough history as diarrhea due to any one of a number of reasons. In the past surgical history appendectomy, cholecystectomy and the gastric bypass are all surgeries that can cause diarrhea. In the medication review there would be concern if the patient has had antibiotics. In the past medical history one can look at travel history and food poisioning can also be an issue.

Once history is complete to look at the anus is a must and with a physical exam sometimes patients have a stenosis of the anus. This would result from prior surgery and/or from chronic anal fissures or chronic diarrhea


If no source of the diarrhea can be determined and there is no resolution with basic treatments above

The next steps are laboratory studies

CBC with differential
Celiac diagnosis panel
send stool sample
Clostridium difficile toxin PCR
C and S (salmonella, shigella, campylobacter and ecoli 1057
ova and parasites for 3 continuous days send stool
giardia antigen in the stool for 3 continuous days
microsporidium, cryptosporidium and isospora

if diarrhea is severe
will treat with metronidazole 500mg tid for 10days

if there is no improvement will get a colonoscopy in 3 weeks




The diarrhea can cause incontinence, in fact it should cause incontinence if your anus is functioning normally.

Incontinence is the impaired ability to control gas or stool. Its severity ranges from mild difficulty with gas control to severe loss of control over liquid and formed stools. Incontinence to stool is a common problem, but often it is not discussed due to embarrassment

Physiologic incontinence is the most important and most common cause of incontinence. Diarrhea is a process that the body use to extricate bad bacteria immediately and forcefully from the body. Therefore the anus more specifically the hemorrhoids will not recognize the soft stool rather only will recognize the formed stool and gas

The first objective is to rule out physiologic incontinence and get patient to have a formed stool with dietary changes

There are many other causes of incontinence.

Treatment of incontinence includes and begins with
Dietary change with the goal of creating a formed stool
Constipating medication if the stool can not be formed with dietary changes and an infectious etiology has been ruled out

After a careful history, physical examination and testing to determine the cause and severity of the problem, treatment can be addressed

Mild problems may be treated very simply with dietary changes and the use of some constipating medications. Diseases which cause inflammation in the rectum, such as colitis, may contribute to anal control problems. Treating these diseases also may eliminate or improve symptoms of incontinence. Sometimes a change in prescribed medications may help.